| ObjectivesThe present study aims to explore the supportive care needs level and development trajectory of bladder perfusion patients after bladder cancer surgery from the first bladder perfusion to bladder perfusion for 2,6 and 8 months;to analyze the predictive effect of demographic factors,disease-related factors,and social psychology-related variables on the trajectory types of different supportive care needs of bladder perfusion patients after bladder cancer surgery,and to find out the independent risk factors that can be intervened,so as to provide reference for medical staff to guide the dynamic management of clinical supportive care needs and formulate continuous nursing management plans.MethodsA convenient sampling method was used to select patients with bladder perfusion after bladder cancer surgery who were hospitalized in the Department of Urology and Oncology of three tertiary hospitals in Henan Province from December 2020 to November 2021.A longitudinal study was conducted to investigate the patients who received bladder perfusion for the first time for 2,6,and 8 months by using the general information questionnaire,34-item Supportive Care Need Survey,Family Partnership Adaption Growth Affection,Resolve Index and Hospital Anxiety and Depression Scale.After data processing,using SPSS 25.0 and Mplus8.3 statistical software for data analysis,statistical test levelα=0.05.The main analysis contents include the description of the basic characteristics of the research object,the development trajectory of supportive care demand and the prediction factors.Data analysis methods includeX~2test,nonparametric test,latent class growth model and logistic regression analysis.Results(1)Analyses of participants involvement.A total of 180 patients were included in this study,and 24patients were lost to follow-up in four bladder perfusion stages.Finally,156 patients participated in the study.The total loss rate was 13.33%,which was lower than the estimated loss rate of 20%.There was no significant difference in age,marital status,education level,gender,family per monthly income,gender,smoking history,residence,medical insurance type,occupation,clinical stage,tumor size,histological type,and other chronic diseases between 156 patients who completed the follow-up and 24 patients who lost the follow-up(P>0.05).(2)Descriptions of supportive care needs level.The scores of supportive care needs in the four stages of bladder perfusion patients were(97.01±10.60),(87.54±10.61),(70.95±8.518)and(67.47±9.639).(3)Analyses of development tendency of supportive care needs.The latent growth curve model found that the supportive care needs of patients after bladder cancer surgery from the first bladder perfusion to bladder perfusion for 2,6 and 8 months showed a quadratic function decreasing trend,with a decrease of9.87 units each time;there were significant individual differences in the initial level and change rate of patients(the variance estimates of intercept factor and slope factor were 132.94 and 8.47,respectively,P<0.001).(4)Analyses of supportive care needs in different developmental trajectories.Based on the latent class growth model,the development trend of supportive care needs of patients with bladder perfusion was as follows:the initial score of supportive care needs in category 1 was at a medium level,and gradually decreased in the follow-up process,showing a stable downward trend and the overall decline rate was7.563(P<0.001),that is,the supportive care needs of patients in this category were low and showed a stable downward trend with the change of bladder perfusion time.The initial score of supportive care needs in category 2 was the highest,but the decline rate was 9.902 during the follow-up(P<0.001).Although the level of supportive care needs in this category was higher,it decreased rapidly with the change of bladder perfusion time.category 1 and category 2 were defined as moderate demand stability group and high demand decline group,respectively.The proportion of each group was 56.0%and 44.0%.(5)Single factor analysis.there were significant differences in the distribution of potential categories between the two groups in terms of age(t=2.126,P=0.035),marital status(X~2=9.283,P=0.020)and education level(X~2=14.282,P=0.003);From T1 to T4,family care was statistically significant in the two categories of the development track of supportive care needs(P<0.05),that is,the scores of this variable in the high demand decline group were lower than those in the low demand slow decline group,and anxiety and depression were also statistically significant in the two categories of the development track of supportive care needs(P<0.05).The scores of these two variables in the high demand decline group were higher than those in the low demand slow decline group;(6)Multivariate logistic regression analysis.compared with the moderate demand stability group,the influencing factors of patients’development into high demand decline group included age,education level,family care and depression.In the education level classification variables,the demand for junior high school was 0.28 times that of primary school(OR=0.28,95%CI 0.10-0.80,P=0.018),and the demand for high school was 0.16 times that of primary school(OR=0.16,95%CI 0.04-0.60,P=0.007).Under the condition of controlling its variables,the advantage ratio of the longitudinal trajectory of supportive care needs to develop into a high demand decline group increased by 0.96 times(OR=0.96,95%CI 0.93-0.99,P=0.009)when the age increased by one year,which was an independent protective factor for patients to develop into a high demand decline group.The advantage ratio of the longitudinal trajectory of supportive care needs to develop into a high demand decline group increased by 0.78 times(OR=0.78,95%CI 0.63-0.97,P=0.025)when the total score of the family care scale increased by one unit,which was the same.For each unit increase in the total score of the depression scale,the demand risk increased by 62.0%(OR=1.62,95%CI 1.25-2.11,P<0.001).Conclusions(1)The overall score of supportive care in patients with bladder perfusion after bladder cancer surgery at different stages from the first bladder perfusion to bladder perfusion for 8 months was at a medium level and showed a quadratic function curve.(2)The development trajectory of supportive care needs in patients with bladder cancer after intravesical instillation has significant group heterogeneity,which can be divided into high demand decline group and moderate demand stability group.The overall level of supportive care needs in patients with high demand decline group is higher.(3)Age,education level,family care and depression can predict the development trajectory types of different supportive care needs of patients. |
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